Penis thickening surgery

Corrective surgery of the male genitalia, in particular, the operation to thicken the penis, as well as increase its length, refers to phalloplasty.

Indications for the procedure

The main goal of phalloplasty is to restore the normal anatomy of the penis and its functions after injuries or to correct congenital anomalies (including the urethra. But there are, in fact, no medical indications for thickening the penis. That is, initially surgical methods were not intended for purely cosmetic use. - an increase in the length or thickness of the male genital organ. However, the development of aesthetic surgical plastics has also affected the genitals. And this, according to most experts, rather refers to the field of the psyche and sexopathology: either men with low self-esteem and insecurity in their sexual viability (and having no idea about the real average size of the penis), or dissatisfied with their sex life and deciding that the operation to thicken the penis or lengthen it will radically improve the situation.[1]

According to British experts, with normal size and functioning, about 45% of men are dissatisfied with their sexual organ; according to ASAPS (American Society for Aesthetic Plastic Surgery) specialists, the number of dissatisfied Americans varies depending on age in the range of 17-38%.

Doctors also note that most men who want to increase the volume of the penis have physiologically normal parameters of the penis, but are seriously concerned about its size, possibly due to the manifestation of pathological dissatisfaction with their external data, that is,  dysmorphophobia .

So aesthetic surgery of the genital organs can increase the self-esteem of complex men, who, by the way, do not know that for seven women out of ten, the size of the penis of the sexual partner does not play such an important role.

Preparation

At the preparatory stage, blood tests are prescribed (general, coagulogram, for STDs, HIV, hepatitis type B and C) and a smear from the urethra (to detect infections of the urogenital tract).

The patient is examined by a urologist-andrologist and visualization of the urogenital zone, since in practice there are many cases when, along with unreasonable concern about the size of the penis, there are certain functional disorders that negatively affect sexual life (for example, premature ejaculation).

The patient should receive all the necessary information regarding the upcoming intervention or procedure, including the actual results of a particular method (since most men have high expectations from phalloplasty), as well as possible complications.

Although plastic surgeons are often convinced of the complete safety of such operations, the results of studies of available methods for thickening (as well as lengthening) the penis in terms of their safety, effectiveness and patient satisfaction are mixed. Such operations are quite risky and not always effective, and patients should be aware of this.

Therefore, it is important to consult a psychotherapist and try to dissuade the patient if he does not have a real problem, but a manifestation of penile dysmorphophobia.

Technique Penis thickening surgery

The specific technique for performing an emiccircumferential phalloplasty that increases the thickness of the penis depends on the method - surgical or non-surgical. At the same time, non-surgical procedures (but still invasive) are still not standardized.

Surgical methods include autoimplantation of an adipofascial (skin-fatty) flap in the form of a strip, which is taken from the inguinal region or from the gluteal fold, and then transferred to the penis and placed between its fascia of Buck and Dartos along the circumference. The operation lasts about seven hours and has many complications (including thickening of the penis tissues, its curvature and shortening, and graft fibrosis). Therefore, it is now resorted to in rare cases. As is the use of Alloderm-type allografts, which are cell-free inert dermal matrices (obtained from donated human skin).

A resorbable cell-free collagen matrix (collagen matrix such as Pelvicol or BellaDerm) is also used, implanted into the penis (around the shaft) under the Dartos fascia either through a transverse suprapubic incision or subcoronal access (with displacement of the skin of the penis). One year after the operation - due to the formation of endogenous tissue - the average thickening of the penis can be from 1.7 to 2.8 cm.

In practice, in most cases, lipofilling is used, as well as such a non-surgical method as subcutaneous injections of gel fillers based on chemically modified hyaluronic acid - a gel implant for thickening the penis.[2]

Under local or epidural anesthesia, lipofilling is performed to enlarge and thicken the penis - autotransplantation of adipose tissue, which is obtained during the first stage of the procedure - liposuction, that is, aspiration (pumping) of fat from the lower part of the peritoneum (through a puncture in the suprapubic region). Adipose tissue is processed (decanted and filtered), and then injected with a syringe using special injection methods along the entire length of the penis shaft or along its circumference. Lipofilling can increase the circumference of the non-erect penis by 2.5-3.2 cm (but the thickness decreases with erection).

The procedure for the introduction of hyaluronic acid-based dermal gel  fillersused for contouring is carried out under local anesthesia (lidocaine is injected into the nerve at the base of the penis). Perlane, Restylane, Juvederm, and Macrolane stabilized gel are used.

Such an injection can make the penis 2.5 cm thicker, but due to the biological degradation of hyaluronic acid - no longer than 10-12 months (Macroline gel - up to a year and a half).[3]

Contraindications to the procedure

Any corrective phalloplasty procedures are contraindicated:

• under the age of 18 and over 60;
• if body temperature is elevated;
• there is bleeding of any localization;
• if patients have infectious diseases, as well as chronic or acute inflammatory processes;
• with sexually transmitted diseases;
• if the level of platelets in the blood is lowered, that is, with poor clotting;
• in the presence of diabetes;
• in cases of dermatological diseases (including fungal), localized in the urogenital region;
• in diseases of autoimmune etiology;
• in psychogenic conditions and mental illness.

The use of hyaluronic acid gel has additional contraindications, including: anogenital papillomas, atopic dermatitis, cutaneous collagenosis, active systemic lupus erythematosus or scleroderma, chronic discoid lupus erythematosus.[4]

Consequences after the procedure

The most likely negative consequences of plastic surgery of the penis in order to thicken it are the formation of soft tissue edema, hematomas, the addition of a secondary infection (with a focus of inflammation), proliferation of connective tissue with scarring.

Complications of autoimplantation of the skin-fat flap are thickening of the tissues of the penis, its curvature and shortening, as well as graft fibrosis.

The use of allografts to thicken the penis is complicated by the formation of erosion, as well as the development of fibrosis and skin resorption, which can shorten the length of the penis and impair its function.

According to clinical data, severe edema of the penis and the development of ischemic ulcers are complications after implantation of the collagen matrix.

Lipofilling does not give a long-term stable result (maximum two years), as there is a gradual resorption of adipocytes. And mechanical trauma to the penis during the procedure can cause fat necrosis.

In addition  to the complications of liposuction , the introduction of adipose tissue into the penis can lead to complications such as the formation of cysts, lipogranulomas and seromas, as well as tissue microcalcifications. As a result, the asymmetry of the penis and the tuberosity of its surface are observed.

Immediately after the injection of the gel with hyaluronic acid, the skin color temporarily changes, edema forms and local numbness occurs. With the superficial introduction of the gel filler (or exceeding its volume), the formation of granulomas is possible. After some time, this procedure can not only reduce the sensitivity of the penis and lead to erectile dysfunction, but also provoke fibrosis.

Therefore, to date, cosmetic fillers are not approved by the FDA for use on the penis, and experts from the International Society for Sexual Medicine also do not recommend their use in phalloplasty.

Care after the procedure

The recovery period - care and rehabilitation after the procedure - does not last long during lipofilling or filler injections. In the absence of obvious complications, patients can go home on the second day. The main care is hygiene and maximum limitation of physical activity.

To reduce swelling, an ice pack is applied (for 5-6 minutes three to four times a day). And in order to facilitate venous outflow, it is recommended to give the penis a vertical position in underwear.

After lipofilling, intimate life is interrupted for two months, and with gel injections, sex resumes after a month.

Reviews

In the middle of the first decade of the 21st century, no more than 35% of patients gave positive feedback on the results of the operation to increase the length and thickness of the penis. By the end of the second decade, according to plastic surgeons, 12 months after the introduction of the gel with hyaluronic acid, 72-75% of patients are satisfied with the result. Although, according to the European Association of Urology, the aesthetic result of this procedure is not satisfactory for almost 78% of patients.

So, first of all, one should take into account the opinion of urologists and andrologists, who note that there are no completely safe and one hundred percent effective methods for thickening the penis.